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Similarly, we were also interested in evaluating for changes in pure\u2010tone thresholds, word\u2010recognition performance, and minimum\u2010masking levels. Both voice and hearing functions were measured repeatedly over a period of 1 year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study design<\/jats:title><jats:p>Longitudinal with repeated\u2010measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Digitized samples of sustained frontal, midline, and back vowels (\/e\/, \/o\/, \/ah\/) were analyzed with computer software to quantify the degree of <jats:italic>jitter<\/jats:italic>, <jats:italic>shimmer<\/jats:italic>, and <jats:italic>harmonic\u2010to\u2010noise ratio<\/jats:italic> contained in these waveforms. Pure\u2010tone thresholds, monosyllabic word\u2010recognition performance, and MMLs were also evaluated for VNS alterations. Linear\u2010regression analysis was the benchmark statistic used to document change over time in voice and hearing status from a baseline condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Most of the regression functions for the vocal samples and audiometric variables had slope values that were <jats:italic>not<\/jats:italic> significantly different from zero. Four of the nine vocal functions showed a significant improvement over time, whereas three of the pure tone regression functions at 2\u20104 kHz showed some degree of decline; all changes observed were for the left ear, all were at adjacent frequencies, and all were ipsilateral to the side of VNS. However, mean pure\u2010tone threshold changes did not exceed 4.29\u2009dB from baseline and therefore, would not be considered clinically significant. In some individuals, larger threshold shifts were observed. No significant regression\/slope effects were observed for word\u2010recognition or MMLs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Quantitative voice analysis and assessment of audiometric variables showed minimal if any evidence of adverse effects using paired\u2010VNS<jats:italic>t<\/jats:italic> over a treatment period of 1 year. Therefore, we conclude that paired\u2010VNS<jats:italic>t<\/jats:italic> is a safe tool for tinnitus abatement in humans without significant side effects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>Level IV.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.364","type":"journal-article","created":{"date-parts":[[2020,3,24]],"date-time":"2020-03-24T14:41:32Z","timestamp":1585060892000},"page":"286-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Vagus nerve stimulation paired with tones for tinnitus suppression: Effects on voice and hearing"],"prefix":"10.1002","volume":"5","author":[{"given":"Helen L.","family":"Kochilas","sequence":"first","affiliation":[{"name":"North Atlanta Ears, Nose, Throat &amp; Allergy, Alpharetta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2407-478X","authenticated-orcid":false,"given":"Anthony T.","family":"Cacace","sequence":"additional","affiliation":[{"name":"Department of Communication Sciences &amp; Disorders, Wayne State University, Detroit Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Arnold","sequence":"additional","affiliation":[{"name":"The Hearing Clinic, Brighton Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4494-7031","authenticated-orcid":false,"given":"Michael D.","family":"Seidman","sequence":"additional","affiliation":[{"name":"Florida ENT Surgical Specialists, Florida Hospital Medical Group, Head &amp; Neck Surgery Center of Florida, Celebration Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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